Provider Demographics
NPI:1063216414
Name:WILDER WELLNESS CENTER
Entity type:Organization
Organization Name:WILDER WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:III
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-456-5901
Mailing Address - Street 1:807 WILLIAMSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8560
Mailing Address - Country:US
Mailing Address - Phone:704-912-4236
Mailing Address - Fax:
Practice Address - Street 1:807 WILLIAMSON RD STE 202
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8560
Practice Address - Country:US
Practice Address - Phone:704-912-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health